神经导航下经皮选择性半月神经节内靶点射频术治疗三叉神经痛的效果

Efficacy of neuronavigation-guided selective percutaneous radiofrequency aiming at the target point semilunar ganglion in treatment of trigeminal neuralgia

目的 评价神经导航下经皮选择性半月神经节内靶点射频术治疗三叉神经痛的效果.方法 原发性三叉神经痛患者147例,性别不限,年龄32～99岁,VAS评分＞8分.采用随机数字表法,将患者分为2组：C型臂组（C组,n =72）和神经导航组（N组,n=75）.C组采用Hartel前入路穿刺法,C型臂引导下以卵圆孔为靶点进行穿刺；N组将头颅MRI影像传输至StealthStation手术导航系统进行重建,在半月神经节内确定靶点位置后设计穿刺径路和穿刺点.记录穿刺成功情况和穿刺及射频术相关不良事件发生情况.分别于术后1d、7d、1个月、6个月、12个月、24个月记录VAS评分,并根据VAS评分评价镇痛效果,术后1、24个月根据Barrow神经研究所评分系统评价治疗效果.结果 N组无一例患者发生穿刺相关不良事件及动眼神经损伤和耳鸣.与C组比较,N组首次手术穿刺成功率升高,术后不同时点镇痛有效率升高,治疗效果较好（P＜0.05）,神经定位时间和面部麻木发生率差异无统计学意义（P＞0.05）.结论 神经导航下经皮选择性半月神经节内靶点射频术治疗三叉神经痛的治疗效果好,复发率低,穿刺成功机率高,且并发症少.

Objective To evaluate the efficacy of neuronavigation-guided selective percutaneous radiofrequency aiming at the target point semilunar ganglion in the treatment of trigeminal neuralgia.Methods One hundred and forty-seven patients with primary trigeminal neuralgia of both sexes,aged 32-99 yr,with VAS score ≥ 8,were randomly divided into 2 groups：C-arm group （group C,n =72） and neuronavigation group （group N,n =72）.Hartel anterior puncture was used and the C-arm guided puncture was performed at the target point foramen ovale in group C.In group N,three-dimensional reconstruction was made after the skull MRI images were transmired to the navigational system of StealthStation,and then the puncture path and point were designed after the target in the trigeminal ganglion was determined.The successful puncture and puncture-and radiofrequency-related complications were also recorded.The VAS scores were recorded at 1 and 7 days and 1,6,12 and 24 months after operation and the analgesic efficacy was evaluated.The therapeutic effect was evaluated by using Barrow Neurological Institute scoring system at 1 and 24 months after operation.Results No puncture-related side effects,damage to the oculomotor nerve or tinnitus developed in group N.The success rate of puncture at first attempt and the effective analgesia rate at different time points after operation were significantly higher,and the treatment effect was better in group N than in group C （P ＜ 0.05）.There was no significant difference in the time for location of the nerve and incidence of facial numbness between the two groups （P ＞ 0.05）.Conclusion Neuronavigation-guided selective percutaneous radiofrequency aiming at the target point semilunar ganglion in the treatment of trigeminal neuralgia provides a better efficacy,and a lower recurrence rate and a higher probability of successful puncture,with fewer complications.